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5至7岁儿童多动症和广泛性发育障碍的婴儿期预测因素:哥本哈根儿童队列CCC2000研究结果

Infancy predictors of hyperkinetic and pervasive developmental disorders at ages 5-7 years: results from the Copenhagen Child Cohort CCC2000.

作者信息

Elberling Hanne, Linneberg Allan, Olsen Else Marie, Houmann Tine, Rask Charlotte Ulrikka, Goodman Robert, Skovgaard Anne Mette

机构信息

Child and Adolescent Psychiatric Centre, Denmark; Research Centre for Prevention and Health, Capital Region of Denmark, Denmark.

出版信息

J Child Psychol Psychiatry. 2014 Dec;55(12):1328-35. doi: 10.1111/jcpp.12256. Epub 2014 May 30.

Abstract

BACKGROUND

Epidemiological studies infancy predictors of mental disorders are scarce.

METHODS

The study is part of a longitudinal birth-cohort study, The Copenhagen Child Cohort CCC2000. Infant mental health and development and mother-infant relations were assessed by community health nurses from birth to age 10 months. Data on the perinatal period were obtained from Danish National Registers. Mental health outcome at age 5-7 years was investigated in 1,585 children who were assessed by the Developmental and Well-Being Assessment (DAWBA) and diagnosed according to the ICD-10.

RESULTS

Predictors of autism spectrum disorders were problems of oral-motor development OR 5.02 (95% CI: 1.63-15.42) and overall development OR 4.24 (95% CI: 1.35-13.33). A deviant pattern of activity and interests were predictive of autism spectrum disorder, OR 5.34 (95% CI 1.45-19.70) and hyperkinetic disorder, OR 4.71 (95% CI: 1.28-17.39). Hyperkinetic disorder was furthermore predicted by mother-infant relationship problems, OR 8.07 (95% CI: 2.90-22.47). The significant associations between infant developmental problems and autism spectrum disorders persisted in multiple logistic regression analyses controlled for maternal psychological problems and mother-infant relationship problems, OR 3.21 (95% CI: 1.09-9.45). Mother-infant relationship problems remained strongly associated to hyperkinetic disorders in the multivariate analyses controlled for child development problems and maternal psychological problems, OR 5.20 (95% CI: 1.55-17.47). No significant infancy predictors were found regarding emotional and behavioural disorders at age 5-7 years.

CONCLUSION

Predictors of autism spectrum/pervasive developmental disorders and hyperkinetic disorders at child age 5-7 years were identified between birth and child age 10 months in community health settings. The study results suggest potential areas of early preventive intervention, which have to be further explored regarding the psychometric qualities of the identification of infants at risk, and concerning methods to handle and intervene towards these children in the general child health surveillance.

摘要

背景

关于婴儿期精神障碍预测因素的流行病学研究很少。

方法

本研究是一项纵向出生队列研究——哥本哈根儿童队列CCC2000的一部分。社区健康护士从出生到10个月大对婴儿的心理健康与发育以及母婴关系进行了评估。围产期数据取自丹麦国家登记处。对1585名儿童进行了5至7岁时心理健康结果的调查,这些儿童通过发育与幸福评估(DAWBA)进行评估,并根据国际疾病分类第10版(ICD - 10)进行诊断。

结果

自闭症谱系障碍的预测因素为口腔运动发育问题,比值比(OR)为5.02(95%置信区间:1.63 - 15.42)以及总体发育问题,OR为4.24(95%置信区间:1.35 - 13.33)。活动和兴趣的异常模式可预测自闭症谱系障碍,OR为5.34(95%置信区间1.45 - 19.70)以及多动障碍,OR为4.71(95%置信区间:1.28 - 17.39)。此外,母婴关系问题可预测多动障碍,OR为8.07(95%置信区间:2.90 - 22.47)。在对母亲心理问题和母婴关系问题进行控制后的多因素逻辑回归分析中,婴儿发育问题与自闭症谱系障碍之间的显著关联依然存在,OR为3.21(95%置信区间:1.09 - 9.45)。在对儿童发育问题和母亲心理问题进行控制的多变量分析中,母婴关系问题与多动障碍仍密切相关,OR为5.20(95%置信区间:1.55 - 17.47)。未发现5至7岁时情绪和行为障碍的显著婴儿期预测因素。

结论

在社区健康环境中,确定了5至7岁儿童自闭症谱系/广泛性发育障碍和多动障碍在出生至10个月大时的预测因素。研究结果表明了早期预防性干预的潜在领域,关于识别高危婴儿的心理测量学特征以及在儿童健康常规监测中针对这些儿童的处理和干预方法,还有待进一步探索。

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